Healthcare Provider Details

I. General information

NPI: 1437183142
Provider Name (Legal Business Name): RUSSELL BARNES VOEGTLEN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/07/2023
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9951 MICKELBERRY RD NW STE 101
SILVERDALE WA
98383-8309
US

IV. Provider business mailing address

9951 MICKELBERRY RD NW STE 101
SILVERDALE WA
98383-8309
US

V. Phone/Fax

Practice location:
  • Phone: 360-692-9362
  • Fax: 360-692-6214
Mailing address:
  • Phone: 360-692-9362
  • Fax: 360-692-6214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00017551
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: